Neurosurgical interventions in the treatment of idiopathic Parkinson disease: neurostimulation and neural implantation

Abstract

With the exception of thalamotomy for drug-refractory tremor, surgical therapy for Parkinson's disease has been almost abandoned as treatment for Parkinsonian symptoms between 1965 and 1985. Reasons for this development relate to inconsistent postoperative results, complications associated with stereotactic surgical techniques and, most importantly, the advent of levodopa, which is still considered to be the gold standard in pharmacotherapy for Parkinson's disease. However, both, the long-term experience with L-DOPA therapy on the one hand and the progress of advanced stereotactic techniques and fetal graft research on the other hand have lead to reconsideration of surgical therapy in Parkinson's disease for patients, who can not be treated satisfactorily with medication. Both lesions (via thermocoagulation) and/or neurostimulation (via chronic intracerebral implantation of electrodes) in thalamic nuclei (nucleus ventralis oralis posterior/intermedialis thalami; VOP/VIM) may alleviate rest tremor in PD patients. In principle neurostimulation has the significant advantage of reversibility with regard to side effects in comparison to lesion surgery. Furthermore ventro-posterior pallidotomy or chronic stimulation in this structures may ameliorate bradykinesia and levodopa-induced dyskinesias. Additionally, "switching-off" the subthalamic nucleus by neurostimulation has been reported to reduce rigidity, bradykinesia and levodopa-induced ON-OFF-fluctuations. On the other hand, neuronal transplantation of fetal nigral dopamine precursor cells aims at restoring the striatal dopamine deficit. Both animal and clinical experiments have shown that fetal grafts survive intrastriatal transplantation and may ensue moderate to satisfactory improvements, especially in regard to bradykinesia and ON-OFF-fluctuations. Further progress in the field of neuronal transplantation will largely depend on the development of alternative cell resources.

Implementing Conventional Zamorano Dujovny Frames versus Individually Manufactured microTargeting™ Platforms - A Comparative Study on Deep Brain Stimulation in Parkinson Patients

“…The subthalamic nucleus (STN) is the key structure for motor control through the basal ganglia and is therefore frequently used as a target for stimulation. By means of STN-DBS, cardinal symptoms of IPD can be improved effectively [1,2,5,6,7]. Clinical experience confirms the beneficial effect of chronic (bilateral) STN-DBS.…”

“…Previous studies have measured the accuracy and targeting error of MT large-case numbers of implantation surgeries, but without direct comparison to frame-based stereotaxy [10,13]. Beneficial effects of bilateral STN stimulation for neurosurgical treatment of IPD have been confirmed by countless studies [1,2,3,4,5,6,7,9,10,16,17,18]. At present, there are several neurosurgical methods for STN-DBS in IPD patients.…”

“…Functional neurosurgery provides a potential alternative treatment for patients with idiopathic Parkinson's disease (IPD) [1,2,3,4]. Deep brain stimulation (DBS) has become an attractive strategy to treat patients who suffer from doses that are continually increasing with the related increased ceiling and side effects.…”

Targeting the Subthalamic Nucleus for Deep Brain Stimulation in Parkinson Disease: The Impact of High Field Strength MRI

“…At present time a wide variety of target localization and implantation techniques exists Kupsch & Earl, 1999). Traditional stereotaxic algorithm has been based on an externally fixed stereotaxic frame that encompasses the patient´s head and upon which the micromanipulating equipment can be mounted and maneuvered with highest accuracy (Dujardin et al, 2001;Martinez-Martin, 2002).…”

“…Dopamine deficiency in Parkinson's disease leads to increased neuronal activity. Regulation of this overactivity using electrical stimulation of the basal ganglia (deep brain stimulation -DBS) has become an attractive neurosurgical option of alternative treatment strategy Kupsch & Earl, 1999). The subthalamic nucleus (STN) is the key structure for motor control through the basal ganglia and is mostly used as stimulation target since here, all cardinal symptoms of PD can be effectively ameliorated (Anderson et al, 2005;Benabid et al, 1998;Dujardin et al, 2001;Limousin et al, 1998;Martinez-Martin et al, 2002;Koller et al, 2001;Krack et al, 1998;Lopiano et al, 2001;Volkmann et al, 2001).…”